ESOPHAGEAL CANCER WITH METASTASIS TO THE THYROID GLAND: CASE REPORT OF A RARE EVENT

Case presentation: The thyroid gland is richly vascularized. However, metastasis to the thyroid is extremely rare. MJC, 70 years old, female, solid dysphagia, dyspnea, hoarseness and significant weight loss, 6 months from the date of the first consultation. Upper digestive endoscopy (UDE) examination showed ulcerated lesion 30 cm from the upper dental arch (UDA), biopsy compatible with malignant neoplasia (April/2018). On staging examinations, neck computed tomography (CT) showed the presence of a large divergent thyroid nodule. Thus, CT-associated positron emission tomography (PET-CT) was requested for diagnostic elucidation, in which there was hypercaptive focal area in the middle thoracic esophagus located below the carina level, compatible with neoplastic process (primary site) and right cervicothoracic lymph node enlargement with level IV cervical involvement, compatible with secondary neoplastic involvement. Cytology of thyroid nodule aspiration confirmed the presence of atypical squamous cells. Closed diagnosis as malignant neoplasm of medical thoracic esophagus with thyroid metastasis. Therefore, we opted for radiotherapy treatment (RT) 28x200cGy and chemotherapy (QT) with cisplatin only (August/2018 until October/2018), in a palliative character. Two months after the end of RT + QT, the patient progressed with bone and liver metastatic disease and one month after generalized metastasis, died. Discussion: The incidence of thyroid gland metastasis ranges from 1.2-24%, with 2-3% being clinically detected. The most common primary sites are breast, lung, gastrointestinal system and kidneys. Thyroid metastasis should not be confused with direct thyroid infiltration due to locally aggressive upper esophageal disease. Overall survival depends on the primary tumor site, with about 21-66 months for breast cancer and 1-12 months for lung cancer. In the described report, the patient had a 9-month survival after diagnosis of thyroid metastasis. Final comments: The case described is a rare event with a poor prognosis. Importantly, there wasn’t right thyroid infiltration due to esophageal disease. Discussion between teams is extremely important because it is a complex scenario. Hence, decisions must be individualized, taking into account the characteristics of the primary tumor, the amount of metastasis and comorbidities.

Publikationsverlauf

Artikel online veröffentlicht:
23. Oktober 2019